HomeMy WebLinkAboutMortgage_Nurrenbern (3)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun nshi Year
_ s FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e Fofm 437091R17 ! fi09)
S,,,, f Pmsaibed by Deparbr�eM ot Lod Gwemment Frmnce
File Mark
�srRUCnoNS: ';��%'
To 6e h7ed in person or 6y mail wifh the CounryAudiror or Counry Recorder of Ne county whe2 the properry is locafed. F� �
Fdirg Dates: 7J Real PropeRy Must file during the year hr which Ihe deduc[ion is soughL �, Qkn�`
2) Mobi7e /Manufaclured Homes rrot assessed as Real Property Must file dunng Me twelve (12) months � �unty er
6efore March 31 of each year Ihe deduction is sought. �
See reverse side /or addif6onal instrucGons arxl qualfications. '-'
�
/'
i vA� d real wwer.r as a
ar2N year
ro, what is his / her exaG share of interest?
If name m reoortl is dMerent fhan that o( appGrant,
Name of mort9agee ar
wrtent yePr
AEtlress of mongagee w mnlract s4Aer (num�i and sheeC ciry. sfaM.
Name of assignee w dha owner w hdder ot mortgage
PLdress of assignee (mim6er ard seee4 mY. �P. � ZIP code)
Dce5 ePWiUnt ovm MoPeNY in anY oNc
oounry in Indiana? 1�'1 .,_'
a
Y�.
DeductionaPP� , .
�I'alT'Lt' 1�'�.. �VOI.. .
�— ..
SigratureofG ai 1 iO. �.. C�a�(/ ' 1•••
„Wece� � �k �r57,.500��.....
owner I contract buyer ot me a...._..._
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exewted Power of Attomey rn by IC 61.1-12-0.7
of aut}wr'¢N person (numbera�d sfree4 ary. sfate, an0
-Uo% 5`�d-Uo
s unpaiE as U Mortgage / Com
dafe af appfmati
��� ��(� ❑ Yes ❑ No
H awne0 wtth someone other n spouu, iMicate wBh whom
as of Is Ne appli�nt Ne sak
1eg21 p equitade oxnM
COUNTYAUDROR
Counry
I5 ihe pmperty in puesGOn: Mnuallyl�ssessM
� Rea� Proaertv ❑ nrmua�y assessed
' � �!�
tw arrent yea(+
I N—
�equestM m prapeity
❑ Yes ❑ No
Oate (monfi, Eay, yea�
20
�rtnalion is We and cortect arW that the applirant is a resident of Indiana aM
is filed.
_ _ , Date (mor�fi. d9Y. Yea�
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